Combining immunosuppressive therapy with low dosage eltrombopag in Chinese patients with severe aplastic anemia: mild aggravation of hepatic injury

Eltrombopag (EPAG) is an oral thrombopoietin receptor agonist analog with the potential risk to induce liver injury. This prospective registry study evaluated the prevalence and severity of hepatic injury in Chinese patients with severe aplastic anemia undergoing low-dose EPAG treatment (75 mg/day) in the context of standard immunosuppressive therapy (IST). The incidence of acute drug-induced liver injury was slightly higher in the IST + EPAG group than in the IST group at the 1st and 2nd month, but no statistically significant difference was observed: 10% vs 5% (p = 0.400), 9% vs 8% (p = 1.000). At the 1st month, the incidences of alanine aminotransferase, aspartate aminotransferase, and total bilirubin increased of grade 3 or higher in the IST + EPAG and the IST groups, were 5% vs 3% (p = 0.228), 2% vs 1% (p = 1.000), 2% vs 1% (p = 1.000), respectively. The logistic analysis indicated that serum ferritin level was associated with severe liver injury events. There was a slight increase in the incidence of severe hepatic injury events in the patients with SAA treated by EPAG, but it was insignificant.